Tuesday, November 18, 2014

Support tobacco-free retailers! (And partner with your local pharmacist!)

When William Shrank, chief scientific and medical officer at CVS Health, first started working at CVS, he and his young daughter stopped by the retailer to pick up a snack. When they got to the cashier, she looked behind the register counter at the wall of cigarettes. She looked up at her dad and asked, “You’re a doctor. How can you be selling cigarettes?”

She promptly told him to tell Troy to do something about it. (That’s Troyen Brennan, executive vice president and chief medical officer at CVS.) It just so happened that this adorable story took place around the same time that CVS actually was considering eliminating tobacco from its stores. And as we all know, CVS eventually did kick tobacco to the curb in September, dropping a product that previously brought the company $2 billion in annual revenue. When Shrank showed his daughter the newspaper headlines about the landmark decision, she was so excited that she told everyone at school that she made it happen.

Of course, the CVS decision to stop selling tobacco involved a lot more than the pleas of a young girl. But her excitement is a sign of a major cultural shift in how we think about tobacco, and CVS’ decision is emblematic of a smoke-free cultural norm that public health helped to build over five decades of anti-tobacco efforts.

“We’re all recognizing more and more that health does not just happen when the patient is sitting in front of the doctor — health happens between those visits to the doctor,” Shrank told attendees during a Tuesday session on “Prescription for Health: Tobacco-Free Pharmacies.”

In the new health care environment ushered in by the Affordable Care Act, we all have to start caring more about what our patients are doing in between visits, said Shrank, noting that CVS Health is the largest retail clinic operator in the nation. In that vein, CVS had long been working to leverage all of its resources toward promoting higher quality and lower costs. But lurking in the background of the company’s drive to promote health was a giant inconsistency — CVS sold tobacco and helped heighten the visibility of the deadly product every time a customer went up the register only to be confronted with a wall of tobacco marketing.

“We took a close look at ourselves,” Shrank said. “We can not purport to be a company focused on health if we are responsible for selling the source of the single most preventable cause of illness in the U.S.”

Today, millions of CVS customers no longer see a wall of cigarettes when they enter and exit the retailer. Instead they see promotions for the company’s many cessation programs and aides. This is public health in action.

“We’ve been really humbled by the support that we’ve gotten from the community, far more than any of us anticipated,” Shrank said. “It’s done big things for morale at CVS and helped us coalesce around this deep, profound vision and belief that we can do something meaningful.”

CVS Health got a lot of applause at the Tuesday session, including a jubilant shout-out from session presenter Fred Mayer, president of Pharmacists Planning Service, Inc., a California nonprofit that offers a wealth of health awareness programs, from smoking cessation in January and February to poisoning prevention in March to cell phone safety in August. (And Mayer was adamant — “Use our campaigns!” he urged attendees.)

Mayer said that his organization launched its first smoking cessation campaign 50 years ago, and having pharmacists on board was key. On many occasions during the session, he urged attendees in seriously enthusiastic fashion to reach out and partner with local pharmacists.

“We are the most available, acceptable and accessible of all health care people,” he said. “Anybody can walk into a pharmacy.”

Mayer said that following the CVS move, he and his colleagues are going after Walgreens to do the same. Spread the message, he said, that dropping tobacco is good for the bottom line.

“You can make more money by being good,” Mayer said. “It’s all about making money, folks…that’s the game.”

To learn more about the CVS decision and ways to build public health-private partnerships to end tobacco use, check out this webcast of an APHA-CVS symposium held in September.

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